The encounter form is the source document used to generate the insurance claim. In addition to patient identification and the date of service, it contains abbreviated diagnosis and brief procedure and service descriptions and corresponding codes (CPT, ICD-9CM, HCPCS).
The provider circles the appropriate codes on the form and the provider’s office staff enters the codes, charges, amount paid by the patient and total due.
Review the Encounter Form (Figure 4-5 in the textbook) to familiarize yourself with its organization and contents. Use the encounter form to answer the following questions:
- Describe what an encounter form is and how it is used in physician’s office and in the hospital.
- Which CPT codes listed on the encounter form are reported for a new patient office visit and why are these needed?
- Which CPT codes listed on the encounter form are reported for office consults and why are these needed?
- The provider performed an EKG with interpretation during an office visit. Identify the CPT code located on the encounter form that would be reported for this service?
- The patient paid his $20 copayment during registration for today’s encounter. What is the title of the section of the encounter from where the amount received is entered?
- During the process of reviewing the encounter form the billing staff notices that the provider checked the procedure for the lab test Mononucleosis but the diagnosis was hypertension. What should the biller do next and why?
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